Healthcare Provider Details

I. General information

NPI: 1346074093
Provider Name (Legal Business Name): ANNA VILLAGOMEZ-CHRISTENSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S CAMINO DEL PUEBLO
BERNALILLO NM
87004-5803
US

IV. Provider business mailing address

560 S CAMINO DEL PUEBLO
BERNALILLO NM
87004-5803
US

V. Phone/Fax

Practice location:
  • Phone: 505-917-9725
  • Fax:
Mailing address:
  • Phone: 505-917-7925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08744
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: